Doctors’ End-of-Life Language, Impact on Patient-Caregiver Decisions (Research, Video 5:23)

Some call it “framing” the conversation a certain way that heightens the odds of a particular response. No matter what the procedure is called, end-of-life decisions about treatment options for critically and terminally ill patients can be influenced greatly by how doctors present information to patients and caregivers.

In a study about doctors’end-of-life language, a simulation involving an older adult with end-stage cancer and life-threatening hypoxia (deficiency of oxygen reaching the tissues ) was followed by a debriefing interview. Doctors participating were hospitalist, emergency medicine, and critical care physicians from three academic medical centers. Their encounters regarding presentation of treatment options were observed in real time and analysed.

Results:

1)  Among 114 physician subjects, 106 discussed life-sustaining treatment, 86 discussed palliative care, and 84 discussed both.

2)  Doctors framed life-sustaining care as necessary (53%), while framing palliative care as optional (49%).

3)  Among doctors who framed life-sustaining care as imperative, 16 (30%) felt intubation (insertion of a tube through mouth and airway to assist with patient’s ventilator breathing) would be inappropriate in this clinical situation.

The majority of doctors framed end-of-life patient options by implying

that life-sustaining treatment was the expected or preferred choice.

Framing options in this way can greatly influence treatment decisions

made by patients and caregivers.

The following video is an excerpt of a televised edition of Frontline. It features patients, families, and doctors facing complicated end-of-life decisions at the Mount Sinai Hospital intensive care unit in New York City:

Frances Shani Parker, Author

Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.

Hospice and Nursing Homes Blog

Do Not Resuscitate (DNR) Order: Should DNR Order of Terminally Ill Patient Attempting Suicide Be Denied? (Research)

Healthcare providers often find themselves immersed in making ethical decisions about their patients' lives. For example, emergency physicians encounter patients who have attempted suicide. These physicians may be faced with the dilemma of either honoring patients' DNR requests or intervening to reverse the effects of potentially fatal suicides. Because terminally ill individuals have a right to refuse life-sustaining treatment by signing a do-not-resuscitate (DNR) order, should their DNR requests be withheld if they attempt suicide? What should doctors do? 

These are doctors' options regarding DNR and attempted suicide: 

1)  Should doctors presume that patients who attempt suicide lack the capacity to make that decision due to acute mental illness and not honor these patients' requests not to be resuscitated? This could reverse the effects of attempted suicides.

2)  Should doctors presume that competent patients have reasonable preferences to not be forced to live in unbearable, terminally ill conditions?

States that do not have legislation allowing physicians to assist in dying have physicians who struggle with these decisions on a case-by-case basis. Some physicians say that patients have a right to refuse life-sustaining treatment when there is limited life expectancy and no concern that the patients have psychiatric illness as the primary cause of suicidal actions. What do you say?

Frances Shani Parker, Author

Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.

Hospice and Nursing Homes Blog